1. TOWARDS COMPETENCY-BASED TRAINING IN UROLOGY
Apul Goel, Ashok K Sokhal, Piyush Gupta
Department of Urology, King George’s Medical University, Lucknow, India
Categorization of procedures as per survey response
INTRODUCTION
Group A – Must Know (vital) procedures
Group B – Good to Know (essential) procedures
Group C – Desirable to Know procedures
Open Simple Nephrectomy
Laparoscopic Simple Nephrectomy
Radical Nephrectomy with vena cava thrombectomy
Open Radical Nephrectomy
Laparoscopic Radical Nephrectomy
Bladder Neck Reconstruction
Open Nephroureterectomy
Laparoscopic Nephroureterectomy
PCN
Partial Nephrectomy
PCNL
Radical Cystectomy with Diversion
URS
Bladder Augmentation
Open Pyeloplasty
HoLEP ( Enucleation )
Transurethral Ureterocoele Incision
Radical Prostatectomy
TURBT
Hypospadias Repair
Cystoscopic Litholapaxy
Cavernosal Shunts
VVF Repair
Flap Urethroplasty
TURP
Vasovasotomy
TRUS Biopsy
Radical orchiectomy with / without RPLND
Partial / Total Penectomy
Stress Urinary Incontinence - Sling Procedures
Direct Vision Internal Urethrotomy
Adrenalectomy
Graft Urethroplasty
Excision and Primary anastomotic urethroplasty
Varicelectomy
Vasectomy
Orchidiopexy
Problems with planning uniform competency-based program
India is a heterogeneous country with the economic status varying from the very rich to the very poor.
The medical facilities vary from the most advanced to the very basic.
These issues make it difficult to provide uniform training to the residents.
Urology is primarily a surgical branch, where the students have to acquire psychomotor skills.
It is difficult for both the trainees and the trainers to acquire all the skills in a limited time span of 3-years.
There is a need to make a uniform policy and identify “must know” procedures that the trainee need to learn.
AIM
To identify core urology operative procedures across India that should be part of urology curriculum through a web-based survey.
MATERIAL & METHODS
A web-based survey using Survey Monkey was conducted between October 2016 and February 2017.
Survey was sent to members of Urological Society of India
The questionnaire broadly comprised set of 5 questions.
The 5th question included list of 37-common urological procedures based on current urology practice that were to be graded.
Respondents were requested to grade psycho-motor competencies into three groups:
Group-A competencies were those that were essential for the trainee to learn (Must know)
Group-B competencies were those that were good to acquire (Good to know)
Group-C procedures were labeled as desirable to know.
List of procedures that can be added into the training program.
RESULTS
Group A
Group B
Group C
Unclassified Requiring Discussion
AV fistula
Ureteric reimplantation
Exploration for Renal Trauma
CAPD catheter Insertion
Flexible URS
Fulguration of PUV
Robotic Procedures
Supra-pubic catheterization
Boari Flap
Open or Laparoscopic Donor nephrectomy
Penile Prosthesis
Open Pyelo- lithotomy
Open prostatectomy
Open Ureteoneocystosotomy
Perineal Urethrostomy
Surgeries for Priapism
Anti-reflux Surgeries
Inguinal block dissection
Internal Iliac Ligation
Laparoscopic Pyeloplasty
Mini Perc
Circumcision
Harvesting Kidney from Cadaver
Out of 3018 forwarded survey questionnaire, 485 (15.75%) responses were received.
The highest number of respondents were from the private-sector (67%).
Among respondents 18% representation came from north-India, 12% from east-India, 30% from west-India, 37% from south-India and 3% from the central zone.
List of procedures with Likert scale presented as weighted means, median and standard deviation
Procedure
Minimum
Maximum
Median
Mean SD
Open Simple Nephrectomy 1 3
1.04
0.22
Open Radical Nephrectomy
1.32
0.54
Laparoscopic Simple Nephrectomy 2
1.77
0.65
Laparoscopic Radical Nephrectomy
2.17
0.68
Open Nephroureterectomy
0.52
Laparoscopic Nephroureterectomy
2.22
0.63
Radical Nephrectomy with vena cava thrombectomy
2.41
Partial Nephrectomy
1.84
0.73
PCN
1.03
0.21
PCNL
1.07
0.28
URS
1.02
0.16
Open Pyeloplasty
1.05
0.25
Transurethral Ureterocoele Incision
1.27
TURBT
Cystoscopic Litholapaxy
0.19
Radical Cystectomy with Diversion
2.02
0.71
Bladder Augmentation
2.13
0.7
Bladder Neck Reconstruction
2.54
VVF Repair
1.56
0.64
TURP
0.17
HoLEP ( Enucleation )
2.28
0.66
Radical Prostatectomy
2.27
TRUS Biopsy
1.18
0.44
Partial / Total Penectomy
1.17
0.42
Hypospadias Repair
1.76
Cavernosal Shunts
2.07
0.77
Direct Vision Internal Urethrotomy
Flap Urethroplasty
1.79
Graft Urethroplasty
1.49
0.6
Excision and Primary anastomotic urethroplasty
1.3
0.53
Varicelectomy
1.12
0.35
Vasectomy
1.11
0.37
Vasovasotomy
2.21
0.75
Orchidiopexy
1.08
0.3
Radical orchiectomy with / without RPLND
1.65
Stress Urinary Incontinence - Sling Procedures
1.74
0.67
Adrenalectomy
1.95
DISCUSSION
Education and training curriculum is shifting from time-based model to competency based model.
Currently > 100 centres have urology training programs in India
Similar attempts can be seen in various other specialties like orthopaedics in ACGME-accredited centres and in the urology itself in the Canadian system 1.
CONCLUSION
This survey will help to formulate a framework for designing a better curriculum.
Our survey positively proves the presence of consensus in current practicing urologists of India towards the 20/35 procedures to be as a part of the core urology competency.
Further additions to the classification system can be made with similar surveys which will make this system more robust and reliable.
REFERENCES
Rourke KF, MacNeily AE. Mapping a competency-based surgical curriculum in urology: Agreement (and discrepancies) in the Canadian national opinion. Can Urol Assoc J. 2016;10(5-6):161.
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